Skull with four trepanned holes. (SSPL/Getty Images)
1) Prehistoric people needed surgery like a hole in the head
In 1865, American archaeologist Ephraim George Squier left Cuzco, Peru, in possession of an ancient Mexican skull given to him by a collector. The artefact was to ignite debate in medical circles on both sides of the Atlantic.
Dating from around 1400–1530 BC, the skull had a rectangular hole in its frontal lobe. Squier shared the find with the New York Academy of Medicine and with French neuroscientist Paul Broca, who showed that the hole had been deliberately made while the person was still alive.
Examples of this ancient practice – trepanning – have since been found worldwide, dating back as far as 10,000 BC. It appears to have developed independently in many cultures, and as a result there’s evidence of various methods: scraping the skull with a sharp flint; boring a circle of holes and prising out the resulting disc; creating a ‘hashtag’ shape of grooves and removing the middle.
But why would people do this? Broca speculated that they were trying to let evil spirits escape from the body. It’s a theory that remains popular today, but we should be aware that it rather suited 19th-century white anthropologists to view indigenous cultures as scientifically inferior.
Also possible is that trepanning was a practical way to treat fractures (the ancient Greeks certainly used it this way). With head wounds a familiar consequence of conflict or accident, practitioners might have observed the course of infection and realised that dead bone would eventually disintegrate (if the patient didn’t die in the meantime). Removing these fragments manually would have been worth a try. We can’t ask ancient communities why they made holes in heads, but their rationale could have been less barbaric than it at first appears.
2) Ancient Egyptian medical specialists included the ‘herdsman of the anus’
Magic, religion and rational science mingled without contradiction in ancient Egyptian healing. A sick person could consult a doctor (called a swnw), a magician or a lay priest – or all three if they felt like it. One practitioner might be both priest and doctor, curing via a combination of medicines, incantations and prayers.
Egypt’s system of medicine was the first to be set down in writing, but its history remained obscure until hieroglyphs started being decoded in the early 19th century. Since then, papyri and depictions in tombs have shown that doctors had an extensive knowledge of disease and a rich pharmacopoeia of herbs, animal products and minerals. Prescriptions were prepared according to precise recipes that included long lists of ingredients and their measurements, and took many forms including pills, ointments, inhalations and enemas.
One doctor particularly skilled in administering these enemas was Irenakhty, who lived in approximately 2150 BC. He was doctor to the royal palace and (among several other titles) held the position of neru pehut – herdsman of the anus. His proctological expertise was not a one-off: his predecessor Khuy was another anal guardian, who combined the role with his skills as a dentist to ensure both ends of the pharaoh’s alimentary canal remained in tip-top condition.
Reconstruction of an ancient Egyptian relief from the Temple of Kom Ombo, showing a collection of surgical instruments. (DeAgostini/Getty Images)
3) Plastic surgeons have long been able to offer new noses for old
The loss of a nose – whether the result of punishment, unluckiness in sword-fighting, or disease – has historically led surgeons to try to restore the patient’s features and dignity.
The Indian surgeon Sushruta (c600 BC) used a plant-leaf template to dissect a flap of skin from the patient’s cheek, leaving it attached by a strip called a pedicle. Twisting it so the wound surface remained downwards, Sushruta would suture it into the place of the missing nose and affix small reed tubes to act as nostrils.
Similar procedures re-emerged in Renaissance Italy, when surgical families the Brancas and the Vianeos developed methods of creating a new nose from the skin of a patient’s arm. It was worth these practitioners’ while, however, to keep the details secret to ward off competition. In 1597, Gaspare Tagliacozzi, professor of anatomy at Bologna, brought nasal reconstruction out into the open by publishing De Curtorum Chirurgia per Insitionem, which aimed to describe rhinoplasty scientifically and educate other surgeons about it.
Tagliacozzi’s operation involved making parallel incisions in the skin of the upper arm and drawing a linen dressing underneath the flesh. After about 14 days, he cut the flap at one end; another 14 days allowed the flap to mature and he then engrafted it to the patient’s nasal cavity, using a system of bandages to keep the arm and face together. After another fortnight, he separated the arm from the nose (much to the patient’s relief) and shaped the graft accordingly. But after Tagliacozzi’s death in 1599, the operation failed to become mainstream. It was not until the late 18th century that European surgeons realised new noses were still being created in India.
A letter to the Gentleman’s Magazine in 1794 told of an Indian army bullock-driver called Cowasjee, who was captured by the sultan and punished as a traitor by having his nose and one hand severed. An unnamed Mahratta surgeon skilfully moulded a new nose from the skin of Cowasjee’s forehead. British surgeon Joseph Constantine Carpue drew upon these reports to begin nasal reconstructions in 1814; his work revived interest in rhinoplasty and helped western surgeons catch up with their Indian counterparts.
Engraving from Tagliacozzi’s ‘De Curtorum Chirurgia per Insitionem’, showing rhinoplasty surgery in which the patient’s nose was attached to a flap of skin on his upper arm. (DeAgostini/Getty Images)
4) Smoking was good for you
The words ‘cigarettes’ and ‘health’ are now unlikely bedfellows. Nineteenth-century medical cigarettes for asthma, however, were part of a long history of inhalation therapy that continues in the inhalers of today.
Ideas about the causes of asthma changed over the centuries, so the inhalation of herbal smoke fell in and out of favour depending on the prevailing theory. By the end of the 18th century, however, asthma was being interpreted as a ‘nervous’ disease caused by spasms of the bronchi. Into this receptive medical environment came the plant datura stramonium, or thorn-apple. Already known in the US, people in Britain began smoking it between 1802 and 1810, after a similar remedy, datura ferox, was brought back by an East India Company physician. Joseph Toulmin, a surgeon from Hackney, substituted the more easily obtainable datura stramonium, gaining relief from his own asthma. Word quickly spread about the new remedy.
At first, stramonium was smoked in ordinary tobacco pipes. It was possible to grow it oneself and dry the roots and stalks (although not the leaves, which have a dangerous narcotic effect). By the middle of the 19th century, smoking was socially acceptable and ever easier with the introduction of cigars, then cigarettes (and matches). Commercial brands of stramonium cigarettes fitted nicely into this context and were not seen as a quack remedy – doctors recommended them as a convenient way of inhaling the drug.
In the early 20th century the spasmodic model of asthma gave way to the concept of allergic inflammation, and this made smoking seem less appropriate. At the same time, new drugs such as ephedrine provided an alternative to the potentially hallucinogenic stramonium. As the dangers of tobacco smoking became more apparent, medicated cigarettes fell out of favour – but, for a while, stramonium had played an important role in bringing relief to those struggling to breathe.
Kellogg’s ‘asthma cigarettes’. (Reg Innell/Toronto Star via Getty Images)
5) The first African-American female doctor graduated at the height of the American Civil War
In May 1869, a doctor addressed the annual meeting of the New England Anti-Slavery Society. Slavery had been abolished in 1865, and the doctor expressed strong hopes for the future for black people. She also gave a prescient warning: it would “take earnest labour on the part of their friends to secure them all their rights.” The speaker was Rebecca Crumpler, the first African-American woman to graduate as a physician. She devoted her career to improving the health status of black people living in poverty, especially women and children.
Crumpler was born Rebecca Davis in Christiana, Delaware, in 1831. She married Wyatt Lee in 1852, settling at Charlestown, Massachusetts. There, she worked as a nurse for local physicians, and these employers supported her successful application to the New England Female Medical College. Her husband died of tuberculosis in 1863 but she persisted with her studies and graduated the following year as ‘doctress of medicine.’ She briefly practised in Boston before travelling to St John in New Brunswick, Canada, where she married Arthur Crumpler in May 1865. She is now remembered as Rebecca Lee Crumpler, although she does not appear to have continued using the name Lee after her second marriage. Sadly, no identifiable photos of her have survived.
With the American Civil War over, Crumpler went to Richmond, Virginia, to work for the Freedmen’s Bureau, a government agency assisting freed slaves and impoverished white people in the former Confederate states. Despite her degree, she is listed in the records as ‘nurse’, receiving $10 per month. As she later explained, however, this part of her career was the ‘real missionary work’ to which she felt called. Serving a population of 30,000 black people emancipated from slavery yet still experiencing violent discrimination, she focused on assisting the poorest families.
Her A Book of Medical Discourses (1883), was one of the earliest medical publications by an African-American writer, and specifically spoke to a female readership. Crumpler realised that knowledge is power and that encouraging women to be active in protecting their own and their children’s health would improve their lives within a difficult context.
6) The tapeworm doctor could expel your unwanted passengers
The beef tapeworm, taenia saginata, can grow to over 20 metres long in the human intestines. As is also the case with its shorter but meaner cousin, the pork tapeworm, it absorbs nutrients from the contents of the digestive system and can survive peacefully for years – unless, that is, its host decides to evict it.
In late 19th and early 20th-century America, the tapeworm provided a profitable career for itinerant practitioners, who travelled from town to town, parting people from their intestinal inhabitants. Such ‘tapeworm specialists’ are not exactly a much-fêted part of the history of medicine, but their activities give an insight into the healthcare options available to rural communities.
When treated by a worm doctor, you would have to fast for a day to get the worm hungry, then take a teaspoon of the essential oil of male fern in a cup of warm milk. After this, you lay down for a few hours before taking a draught of castor oil, turpentine and croton oil – the latter being toxic and a drastic laxative. The spectacular effects of this mixture can readily be imagined.
Some tapeworm specialists were showmen, impressing the punters by displaying preserved ‘worms’ of enormous length. These were more likely to be fakes made from animal entrails than the real thing, so the tapeworm doctor became a fairly disreputable character. He’s unlikely to be commemorated with a statue outside a hospital or a reverent biography detailing his selfless quest for medical progress, but he was part of the colourful variety of healthcare providers to whom the average person could turn when unable to afford a physician.
1812 copperplate engraving of a parasitic tapeworm. (Florilegius/SSPL/Getty Images)
7) Plague and inequality joined forces at the turn of the 20th century
The word ‘plague’ sounds inherently medieval, but the Third Plague Pandemic finished within living memory. Previous pandemics had wiped people out indiscriminately, but this one disproportionately affected those living in poverty, highlighting the global health inequality that has been worsening ever since.
The Third Pandemic emerged in China in the 1850s and crossed international borders during the 1890s. From Hong Kong in 1894, rats infested with plague-carrying fleas starting travelling the world on colonial supply ships, taking their lethal bacteria to every inhabited continent.
The bacterium – yersinia pestis – was isolated the same year (1894) by Alexandre Yersin and Kitasato Shibasaburō, who independently found it within days of each other. In 1898 Paul-Louis Simond established rat fleas as the vector, or transmitter. As the disease spread to international ports, however, public health officials responded with quarantine programmes that isolated suspected sufferers on the assumption that the disease could pass from one human to another.
Draconian measures by the British government in India led to political unrest; in the United States, existing anti-Asian prejudice fed on the disease’s Chinese origin. When plague reached Cape Town via Argentina in 1901, its first victims were black dockworkers. South Africa’s colonial government used this as a pretext to remove the African population of District Six, forcing them under armed guard to a location outside the city at Uitvlugt (Ndabeni). Segregation, which had been regularly mooted on ostensible health grounds for the previous two decades, began in earnest.
The Third Pandemic killed around 15 million people, the majority in India and Africa. The disease’s pandemic status officially ended in 1959, but plague has never been eradicated, and although yersinia pestis remains susceptible to the antibiotic streptomycin, multi-drug resistant strains occasionally surface. Let’s hope future historians do not have to analyse a Fourth Plague Pandemic.
Caroline Rance blogs at www.thequackdoctor.com about the history of medical advertising and health fraud. She recently appeared on BBC2’s Great British Railway Journeys. Her latest book, The History of Medicine in 100 Facts, explores medicine’s history in bite-sized topics, from prehistoric parasites to the threat of antibiotic resistance. Caroline is on twitter as @quackwriter and her Facebook page is www.facebook.com/quackdoctor.